Multiple GI Conditions/Diseases Flashcards
Provide differential diagnoses for abdominal pain by location (RUQ, LUQ, Epigastric, RLQ with diarrhea, LLQ with diarrhea).
RUQ:
- Cholecystitis
- Acute hepatitis
- Other (i.e., hepatobiliary)
LUQ:
- Acute MI
- PUD (peptic ulcer disease)
- GERD
- Pancreatitis
- Gastritis
- Splenic etiologies
Epigastric:
- Pancreatitis
- Gastric etiologies
RLQ with diarrhea:
- Crohn’s
LLQ with diarrhea:
- Diverticulitis
Describe the signs, symptoms, and patient presentation associated with acute cholecystitis.
- RUQ or epigastric pain
- Fever
- Lying down and/or sitting still
- Murphy sign = classic sign:
- inspiratory arrest with RUQ palpation - Lymphocytosis (elevated WBCs)
What is the gold standard diagnostic test for acute cholecystitis and the corresponding positive result?
Test:
Ultrasound of the abdomen
Result:
Thickening of gall bladder wall due to increased muscle use
What abnormal labs would be expected with complicated cholecystitis? What do they indicate?
Elevated:
- ALT, AST: liver involvement
- Amylase: pancreas involvement
Describe diagnostic signs associated with acute appendicitis.
McBurney:
- RLQ pain with RLQ palpation
Rovsing:
- RLQ pain with LLQ palpation
Dunphy:
- RLQ pain with coughing
Psoas:
- RLQ pain with passive extension of R leg and resistance of R hip
Obturator:
- RLQ pain with internal rotation of flexed R thigh
Describe the signs, symptoms, abnormal labs and diagnostic test results associated with acute appendicitis.
S/S:
- Fever/chills
- Nausea/vomiting
- Decreased appetite
- Abdominal distension/rigidity
Abnormal labs:
- WBCs > 10,000
- Bands present
Diagnostic Tests:
- Ultrasound
- CT
Define diverticulum and diverticula.
Diverticulum: Sac-like protrusion [of the colon]
(singular)
Diverticula: Many small sac-like protrusions [of the colon]
(plural)
Of patients with diverticula, approximately what percentage were asymptomatic? What percentage experience diverticular bleeding? What percentage develop diverticulitis?
Asymptomatic: 70% - 80%
Diverticular bleeding: 5% - 15%
Diverticulitis: 4% - 15%
What are possible complications of diverticula/um or diverticulitis?
- Abscess
- Obstruction
- Fistula
- Perforation
List signs and symptoms associated with uncomplicated diverticulitis.
- Low-grade fever
- Leukocytosis
- LLQ abdominal pain
- Nausea/vomiting
For patients with diverticulitis, what is the recommended timeframe for maintenance colonoscopy?
Every 1 - 2 years
Name potential etiologies of diarrhea.
- Infectious etiology
- Irritable bowel syndrome
- Inflammatory disease:
- Crohn’s disease
- Ulcerative colitis - Colitis
- Other, including lactose intolerance
When evaluating a patient with diarrhea, what details should be gleaned from the patient’s history?
- Duration
- Frequency
- Associated signs and symptoms
Describe diarrhea characteristics associated with the small intestine and large intestine.
Small intestine:
- Watery
- Bloating
- Large volume
- Gas
- Cramping
Large intestine:
- Frequent
- Painful
- Regular
- Small volume
- Fever
- Bloody
- Mucoid
What is important to assess in patients with diarrhea other than the details and characteristics of the diarrhea itself?
Fluid volume status
Describe the course of diarrhea of infectious etiology.
Usually:
- Viral
- Self-limiting
Name the likely non-viral infectious agents of diarrhea of infectious etiology.
Bacterial:
- Salmonella
- Shigella
- Campylobacter
- Staph
- C Difficile
- Others
Parasitic:
- Giardia
- Others
What are red flags associated with diarrhea?
- Rectal bleeding
- Nocturnal or progressive abdominal pain
- Weight loss
- Labs:
- Anemia
- Elevated inflammatory markers
- Electrolyte imbalance
How prevalent is Irritable Bowel Syndrome?
Most commonly diagnosed GI condition
NOTE: Condition involving a QUALITY of life problem, not a QUANTITY of life problem
Describe signs and symptoms associated with Irritable Bowel Syndrome.
Crampy, abdominal pain, variable in location and character:
- Diarrhea
- Constipation
- Diarrhea and constipation alternating
- Normal bowel habits alternating with diarrhea and/or constipation
- Mucus present in stools
Other GI symptoms:
- GERD
- Nausea/vomiting
- Early satiety
- Chest pain
Provide potential differential diagnoses for the following signs and symptoms associated with hematochezia:
- Anal pain with/after defection
- Night sweats, fever, weight loss
- Diarrhea before/with passage of blood
- Change in frequency/caliber of stools
Anal pain with/after defection:
- Anal fissure
- Rectal carcinoma
Night sweats, fever, weight loss:
- Malignancy
- Chronic infection/inflammation
Diarrhea before/with passage of blood:
- Colitis
Change in frequency/caliber of stools:
- Malignancy
Per guidelines, at what age should the general population have colorectal cancer screening?
What is the gold standard diagnostic test for colorectal cancer screening?
> 45 years
Colonoscopy
